Supplier – ID supplier reliability total deliveries per year 3002 3003 3006 3011 3012 3016 3017 3019 3020 3021 3022 3023 3024 3026 3027 3030 3031 3032 3033 3034 3035 3036 3037 3038 3039 3041 3042 3043 3044 3045 3047 3048 3050 3051 3056 3058 3059 3060 3062 3064 3065 3066 3068 3069 3071 3072 3074 3079 3080 3081 3083 3084 3085 3086 3087 3088 3089 3091 3094 3095 3097 3098 3099 3100 3101 3102 3103 3105 3106 3109 3111 3112 3113 3116 3117 3118 3119 3120 3125 3126 3127 3128 3130 3132 3136 3138 3140 3142 3143 3144 3145 3146 3150 3151 3152 3156 3157 3158 3160 3161 3163 3164 3165 3168 3170 3171 3173 3174 3175 3176 3178 3181 3182 3183 3184 3185 3186 3187 3190 3191 3192 3193 3195 3196 3197 3200 3201 3205 3206 3207 3208 3209 3211 3212 3213 3214 3215 3216 3217 3218 3219 1 782 28 53 423 187 347 680 278 25 24 642 100 339 24 150 436 178 125 507 24 32 19 111 735 214 18 250 1191 35 12 12 32 460 219 799 4 149 706 96 124 1000 115 685 1199 652 4 221 279 3 14 45 2 43 12 94 768 673 727 76 26 26 136 456 231 730 1539 270 0 1 1477 102 16 36 355 33 140 15 317 497 101 36 57 146 192 355 157 202 23 291 960 11 2041 26 46 66 175 1030 45 39 276 54 218 118 75 2 94 650 169 38 484 24 1 1083 22 1494 92 105 6 8 438 138 717 161 31 120 37 190 584 660 333 30 390 842 954 15 2079 683 138 12 28 supplier importance on-time deliveries per year 0 11 10 36 250 4 54 87 110 4 4 435 22 25 2 21 285 15 115 158 5 1 9 88 154 8 6 4 566 2 1 7 11 253 70 60 0 33 292 11 42 45 23 149 353 12 1 71 1 0 2 22 1 7 5 3 29 44 553 4 3 6 31 10 6 13 324 24 0 1 34 22 1 2 142 5 26 2 273 45 7 1 20 68 10 6 24 23 5 70 44 3 58 2 2 8 35 791 10 14 4 10 72 6 5 0 15 2 43 2 38 1 0 166 1 155 21 16 2 4 78 1 2 18 2 21 2 8 9 3 197 7 197 82 346 4 88 28 36 0 0 supplier dispensability supplier manageability number of variants in product time needed to switch to an distance [in km] between our group loading wagon where optional supplier and to headquarters and the parts of this supplier are used secure reliable supply supplier’s premisses 1 up to 3 weeks 623 10 up to 3 weeks 219 1 up to 3 weeks 293 7 >6 weeks to 6 months 41 12 >6 weeks to 6 months 21 10 more than 12 months 378 13 up to 3 weeks 61 10 up to 3 weeks 34 1 >6 weeks to 6 months 50 4 3 to 6 weeks 243 1 3 to 6 weeks 205 138 up to 3 weeks 41 13 >6 weeks to 6 months 223 1 >6 months to 1 year 625 3 up to 3 weeks 36 4 up to 3 weeks 570 7 >6 weeks to 6 months 913 23 3 to 6 weeks 33 1 >6 weeks to 6 months 124 9 up to 3 weeks 918 1 up to 3 weeks 788 1 up to 3 weeks 24 1 >6 weeks to 6 months 222 1 >6 weeks to 6 months 388 43 >6 weeks to 6 months 54 5 >6 weeks to 6 months 208 10 3 to 6 weeks 1400 7 >6 weeks to 6 months 238 4 >6 weeks to 6 months 15 1 up to 3 weeks 11 3 >6 weeks to 6 months 21 3 up to 3 weeks 49 1 3 to 6 weeks 215 3 >6 weeks to 6 months 128 32 >6 months to 1 year 224 1 >6 weeks to 6 months 926 1 >6 weeks to 6 months 31 6 >6 weeks to 6 months 222 16 >6 weeks to 6 months 48 13 3 to 6 weeks 413 3 more than 12 months 210 3 3 to 6 weeks 728 8 more than 12 months 601 5 more than 12 months 660 68 >6 weeks to 6 months 47 9 >6 weeks to 6 months 189 1 up to 3 weeks A Supply Chain Management Farmco Study Case

A Supply Chain Management Farmco Study Case. 723 1 3 to 6 weeks 36 3 >6 months to 1 year 51 8 >6 weeks to 6 months 217 1 up to 3 weeks 260 1 >6 weeks to 6 months 81 1 3 to 6 weeks 228 3 >6 weeks to 6 months 221 1 >6 months to 1 year 231 1 3 to 6 weeks 452 1 >6 months to 1 year 23 1 up to 3 weeks 255 29 >6 months to 1 year 36 6 >6 weeks to 6 months 669 8 >6 weeks to 6 months 764 2 >6 weeks to 6 months 36 1 3 to 6 weeks 708 1 3 to 6 weeks 535 4 3 to 6 weeks 50 1 3 to 6 weeks 758 133 >6 weeks to 6 months 20 10 >6 weeks to 6 months 221 1 >6 weeks to 6 months 20 3 more than 12 months 629 1 3 to 6 weeks 404 6 >6 months to 1 year 32 3 >6 months to 1 year 174 5 >6 weeks to 6 months 722 1 >6 months to 1 year 200 1 3 to 6 weeks 310 1 >6 weeks to 6 months 230 1 >6 weeks to 6 months 20 1 3 to 6 weeks 633 1 3 to 6 weeks 51 2 >6 weeks to 6 months 257 1 more than 12 months 51 3 >6 months to 1 year 2188 5 >6 weeks to 6 months 239 3 >6 months to 1 year 217 1 3 to 6 weeks 448 3 3 to 6 weeks 46 2 >6 weeks to 6 months 171 3 >6 weeks to 6 months 215 8 >6 weeks to 6 months 211 16 3 to 6 weeks 232 2 3 to 6 weeks 699 1 >6 weeks to 6 months 444 1 up to 3 weeks 19 3 3 to 6 weeks 890 4 >6 weeks to 6 months 219 3 >6 weeks to 6 months 635 1 3 to 6 weeks 54 2 >6 weeks to 6 months 58 1 more than 12 months 909 11 >6 weeks to 6 months 23 1 >6 weeks to 6 months 624 1 3 to 6 weeks 23 4 >6 months to 1 year 218 8 >6 weeks to 6 months 59 1 3 to 6 weeks 16 7 >6 weeks to 6 months 235 6 >6 weeks to 6 months 219 2 >6 months to 1 year 242 16 >6 weeks to 6 months 454 8 more than 12 months 75 3 3 to 6 weeks 23 1 3 to 6 weeks 47 40 >6 weeks to 6 months 126 3 3 to 6 weeks 217 1 >6 weeks to 6 months 18 2 3 to 6 weeks 35 7 3 to 6 weeks 22 3 3 to 6 weeks 720 1 >6 weeks to 6 months 238 6 >6 weeks to 6 months 20 5 >6 weeks to 6 months 18 4 >6 weeks to 6 months 10 2 >6 weeks to 6 months 672 2 up to 3 weeks 181 4 >6 months to 1 year 866 3 >6 weeks to 6 months 281 1 more than 12 months 217 17 3 to 6 weeks 224 19 3 to 6 weeks 730 1 3 to 6 weeks 35 51 >6 weeks to 6 months 33 1 3 to 6 weeks 0 11 >6 weeks to 6 months 17 85 >6 weeks to 6 months 46 1 3 to 6 weeks 652 1 3 to 6 weeks 422 21 more than 12 months 583 5 3 to 6 weeks 229 1 >6 weeks to 6 months 51 1 3 to 6 weeks 885 Supplier – ID supplier reliability total deliveries per year 3012 3017 3019 3020 3023 3024 3031 3032 3034 3037 3038 3039 3043 3044 3045 3050 3051 3054 3060 3061 3062 3064 3065 3071 3072 3073 3077 3078 3079 3082 3089 3091 3094 3097 3099 3101 3103 3105 3106 3110 3112 3116 3117 3119 3121 3124 3126 3132 3139 3140 3144 3145 3147 3150 3151 3152 3154 3156 3158 3159 3162 3163 3166 3169 3173 3174 3175 3178 3183 3184 3187 3188 3192 3195 3196 3197 3199 3203 3204 3205 3207 3208 3209 3210 3212 3213 A Supply Chain Management Farmco Study Case

A Supply Chain Management Farmco Study Case. 3214 3215 3217 423 347 680 278 642 100 436 178 507 19 111 735 250 1191 35 32 460 173 149 229 706 96 124 1199 652 103 40 19 221 221 768 673 727 26 136 231 1539 270 0 29 102 36 355 140 186 3 497 146 55 157 291 960 5 2041 26 46 1 66 1030 67 2 276 2 0 94 650 169 484 1083 22 105 31 438 717 161 31 14 46 335 190 660 333 30 62 842 954 15 2079 138 supplier importance on-time deliveries per year 250 54 87 110 435 22 285 15 158 9 88 154 4 566 2 11 253 19 33 15 292 11 42 353 12 10 4 1 71 13 29 44 553 3 31 6 324 24 0 5 22 2 142 26 4 0 45 68 6 24 70 44 4 58 2 2 0 8 791 0 1 4 0 0 15 2 43 38 166 1 16 18 78 2 18 2 0 1 77 8 3 197 7 4 82 346 4 88 36 supplier dispensability supplier manageability number of variants in time needed to switch to an distance [in km] between our product group plough where optional supplier and to headquarters and the parts of this supplier are used secure reliable supply supplier’s premisses 4 >6 weeks to 6 months 21 57 up to 3 weeks 61 9 up to 3 weeks 34 6 >6 weeks to 6 months 50 224 up to 3 weeks 41 23 >6 weeks to 6 months 223 25 >6 weeks to 6 months 913 18 3 to 6 weeks 33 2 up to 3 weeks 918 1 >6 weeks to 6 months 222 1 >6 weeks to 6 months 388 169 >6 weeks to 6 months 54 43 >6 weeks to 6 months 238 14 >6 weeks to 6 months 15 1 up to 3 weeks 11 3 3 to 6 weeks 215 2 >6 weeks to 6 months 128 21 more than 12 months 107 5 >6 weeks to 6 months 222 39 more than 12 months 622 119 >6 weeks to 6 months 48 2 3 to 6 weeks 413 3 more than 12 months 210 51 >6 weeks to 6 months 47 6 >6 weeks to 6 months 189 1 more than 12 months 187 2 3 to 6 weeks 239 1 3 to 6 weeks 454 5 3 to 6 weeks 36 7 >6 weeks to 6 months 253 1 >6 months to 1 year 23 15 up to 3 weeks 255 45 >6 months to 1 year 36 1 >6 weeks to 6 months 764 1 3 to 6 weeks 708 19 3 to 6 weeks 50 171 >6 weeks to 6 months 20 4 >6 weeks to 6 months 221 3 >6 weeks to 6 months 20 2 3 to 6 weeks 343 2 >6 months to 1 year 32 16 >6 weeks to 6 months 722 1 >6 months to 1 year 200 3 >6 weeks to 6 months 230 81 more than 12 months 394 1 up to 3 weeks 619 1 3 to 6 weeks 49 1 >6 weeks to 6 months 239 81 up to 3 weeks 1746 10 3 to 6 weeks 43 13 >6 weeks to 6 months 211 22 3 to 6 weeks 232 5 up to 3 weeks 868 1 >6 weeks to 6 months 444 4 up to 3 weeks 19 7 3 to 6 weeks 890 1 up to 3 weeks 461 17 >6 weeks to 6 months 219 1 3 to 6 weeks 54 2 >6 weeks to 6 months 80 5 >6 weeks to 6 months 428 21 >6 weeks to 6 months 23 1 3 to 6 weeks 728 2 3 to 6 weeks 217 39 >6 weeks to 6 months 235 15 >6 weeks to 6 months 219 8 >6 months to 1 year 73 8 more than 12 months 75 72 >6 weeks to 6 months 126 1 3 to 6 weeks 217 7 3 to 6 weeks 22 7 more than 12 months 287 2 >6 weeks to 6 months 20 1 >6 weeks to 6 months 10 2 >6 weeks to 6 months 672 4 up to 3 weeks 181 3 more than 12 months 487 2 more than 12 months 698 100 more than 12 months 50 2 more than 12 months 217 29 3 to 6 weeks 730 1 3 to 6 weeks 35 2 >6 weeks to 6 months 33 14 3 to 6 weeks 75 1 >6 weeks to 6 months 17 183 >6 weeks to 6 months 46 1 3 to 6 weeks 652 1 3 to 6 weeks 422 1 3 to 6 weeks 229 Supplier -A Supply Chain Management Farmco Study Case

ID 3002 3003 3006 3011 3012 3016 3017 3019 3020 3021 3022 3023 3024 3026 3027 3030 3031 3032 3033 3034 3035 3036 3037 3038 3039 3041 3042 3043 3044 3045 3047 3048 3050 3051 3054 3056 3058 3059 3060 3061 3062 3064 3065 purchasing volume total amount [€] last fiscal year € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € 645 4.593.698 17.731 264.180 261.022 791.138 38.536 527.320 760.360 88.811 5.245 87.859 152.533 936.168 53.903 889.485 1.268.524 32.678 755.507 2.264.703 80.935 8.402 12.420 390.755 4.321.420 100.345 21.744 18.497 199.382 16.446 8.486 1.609 4.696 1.232.827 87.325 2.488.738 1.184.552 1.015 371.361 907.656 1.443.950 192.734 334.516 3066 3068 3069 3071 3072 3073 3074 3077 3079 3080 3081 3082 3083 3084 3085 3086 3087 3088 3089 3091 3094 3095 3097 3098 3099 3100 3101 3102 3103 3105 3106 3109 3110 3111 3112 3113 3116 3117 3118 3119 3120 3121 3124 3125 3126 3127 3128 € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € 752.013 1.214.691 2.648.972 117.280 423.370 357.000 6.673 87.213 101.852 292.418 2.792 495.003 24.140 58.718 18.226 42.900 26.155 62.660 2.192.960 699.535 645.909 23.642 81.189 17.362 86.509 576.164 91.780 1.402.514 211.626 134.814 103.215 22.501 49.235 1.622.467 93.210 116.812 10.737 1.485.242 163.895 286.564 14.821 1.325.140 785 633.025 417.327 371.360 139.886 3130 3132 3136 3138 3139 3140 3142 3143 3144 3145 3146 3147 3150 3151 3152 3154 3156 3157 3158 3159 3160 3161 3162 3163 3164 3165 3166 3168 3169 3170 3171 3173 3174 3175 3176 3178 3181 3182 3183 3184 3185 3186 3187 3188 3190 3191 3192 € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € 673.669 65.495 255.363 537.178 785.320 140.267 570.564 12.301 298.476 987.258 7.212 185.000 638.456 16.186 7.251 123.000 14.420 89.872 792.541 746.213 88.281 378.414 49.200 351.562 109.609 101.900 18.200 106.931 132.141 361 175.285 233.093 112.026 15.841 801.218 4.505 35 1.916.768 1.258 95.170 123.355 13.001 458.396 2.197 43.073 165.392 3193 3195 3196 3197 3199 3200 3201 3203 3204 3205 3206 3207 3208 3209 3210 3211 3212 3213 3214 3215 3216 3217 3218 3219 € € € € € € € € € € € € € € € € € € € € € € € € 51.072 487.357 645.464 514.193 243.010 456.043 21.535 1.023.578 1.896.000 2.517.779 263.096 166.827 264.969 133.901 548.000 237 422.000 5.088.484 2.027 1.979.839 1.285.872 69.171 16.656 243.142 supplier-ID complaints 3002 0 3003 42 3006 1 3011 0 3012 1 3016 7 3017 0 3019 5 3020 0 3021 8 3022 16 3023 0 3024 0 3026 30 3027 4 3030 58 3031 262 3032 0 3033 0 3034 2 3035 0 3036 0 3037 0 3038 1 3039 0 3041 4 3042 0 3043 0 3044 1 3045 1 3047 0 3048 0 3050 0 3051 1 3054 3 3056 11 3058 0 3059 0 3060 0 3061 90 3062 4 3064 0 3065 0 3066 10 3068 73 3069 167 3071 203 3072 0 3073 4 3074 3077 3078 3079 3080 3081 3082 3083 3084 3085 3086 3087 3088 3089 3091 3094 3095 3097 3098 3099 3100 3101 3102 3103 3105 3106 3109 3110 3111 3112 3113 3116 3117 3118 3119 3120 3121 3124 3125 3126 3127 3128 3130 3132 3136 3138 3139 3140 3142 3143 0 0 0 0 60 1 6 1 1 0 0 0 2 9 12 68 0 2 2 0 22 0 18 12 0 1 2 0 36 0 0 0 13 0 0 0 0 0 4 6 7 1 3 0 0 25 1 0 0 0 3144 3145 3146 3147 3150 3151 3152 3154 3156 3157 3158 3159 3160 3161 3162 3163 3164 3165 3166 3168 3169 3170 3171 3173 3174 3175 3176 3178 3181 3182 3183 3184 3185 3186 3187 3188 3190 3191 3192 3193 3195 3196 3197 3199 3200 3201 3203 3204 3205 3206 0 17 0 0 18 1 0 0 0 2 3 0 1 14 0 1 0 2 0 1 0 3 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 1 1 0 0 3 0 0 0 13 2 3207 3208 3209 3210 3211 3212 3213 3214 3215 3216 3217 3218 3219 58 1 0 64 0 0 3 0 70 370 0 0 1 A Supply Chain Management Farmco Study Case

Co FarmC The C Complexitty of Evalluating Su uppliers Casee Prepareed By: Markkus Gerschhberger, FH-Steyr, A Austria Illa Manuj, FH-Steyr,, Austria and a UNT-D Denton, U USA Updatedd Octoberr 29, 2014 Acknow wledgement: The authorss would likee to acknowledge the suupport of Euuropean Com mmission’s Marie C Curie Actionss (SCCompllexity-6284223 Internatioonal Incominng Fellowshiip) for their support of this projject. The auuthors are grrateful to Dr. Theodoree (Ted) Farriis for unconnditionally sharing s his case devvelopment m materials andd for his guiddance in prepparation of thhis case. FarmC Co The com mplexity of e evaluating s suppliers Page 1 FARMC CO F FarmCo is a mid-sizedd manufactuurer of farm m equipmennt based in Austria. FaarmCo has positioned itself as a premium manufacture m er offering ccustomized products p andd a 30 year sspare parts maining com mpetitive in warrantyy. The abilityy to providee excellent cuustomer servvice is imperative to rem their nicche market ssegment. Prooducts are m made at three productionns sites (Austria, Czechh Republic, and Gerrmany) by 1,100 1 emplooyees resultiing in an annnual turnovver of €180 million. Products are divided into two maajor market segments – grassland aand tillage – and over 800 product grroups. The most im mportant prooduct group is the loadding wagonn accountingg for over 20% 2 of thee company turnoverr. A one of tthe key meaasures of cuustomer servvice FarmCoo counts thee number off customer As complainnts. Recentlly FarmCo has been getting moree than usuall complaintss from the customers. c Klaus S Staberhofer, FarmCo CEO, summooned Raimuund Schüsteer, the SC m manager, annd Johann Steiner, VP of Finannce, into his office. K Klaus begann, “I am gettiing an increaasing numbeer of complaaints from ouur customerss. Where is the probblem?” R Raimund suuspected thatt Klaus had called the m meeting for tthis very reaason. He repplied, “We are havinng some prooblems with the supplierrs which affe fect our prodduction scheddules and deeliveries to customeers, and at tim mes, the quaality of the fiinal product..” “ “Tell me more,” m demannded Klaus. “What is the problem m? Is it relaated to the quality of components they aree supplying uus?” “ “Well, to a very limitedd extent, it is material qquality. Theere are otherr things thatt are more importannt like lead ttimes, distannces, and abiility to find aan alternativve supplier”, replied Raim mund. J Johann appeeared to be a little impattient, “Why are you discussing thesse things witth me? Do these afffect financiaal outcomes??” FarmC Co The com mplexity of e evaluating s suppliers Page 2 R Raimund ressponded, “Thhese things are related too how we m measure suppplier perform mance, how we rewaard or penaliize supplierss, and how w we award conntracts. We spend moneey managingg suppliers. If we can c identifyy which supppliers to fo focus on, thhen we willl spend less money onn supplier managem ment. The m money saved will be a dirrect additionn to the comppany profit.”” N Now Johannn was intereested, “I am m listening. A Supply Chain Management Farmco Study Case

K Keep going. Tell me w what makes a supplier critical?” R Raimund coontinued, “I think we nneed to talk to the purcchasing mannagers to annswer your questionn. Let me gett back to youu in two dayys.” R CRITICA AL? WHAT MAKES A SUPPLIER T Two days laater, all threee met again,, this time inn Raimund’ss office where he had m many charts lying onn his desk. R Raimund beegan, “I starrted by asking our purrchasing maanagers abouut the most important characteeristics for suuppliers. It all a boils dow wn to the folllowing four:: supplier relliability (SR R), supplier manageaability (SM)), supplier iimportance ((SI), and suupplier dispeensability (S SD). SR, as the name suggestss, is the reliaability of the supplier in terms of leadd times. SM M is the ease oof doing bussiness with a supplier which in turn makes the supplierr more manaageable. Suppplier imporrtance is thee criticality of a suppplier to our internal opeerations. Finnally, suppliier dispensabbility is the difficulty inn finding a replacem ment supplieer.” “ “Okay. So, now we cann identify thhe critical suuppliers. I aam sure we have the daata.” Klaus said. R Raimund coontinued, “W We have lots of raw data. How wever, convverting it innto usable informattion is the chhallenging taask.” FarmC Co The com mplexity of e evaluating s suppliers Page 3 J Johann interrjected, “I have h an inteern, Ingrid Legenstein, L who is veryy good withh numbers. Would you y have a uuse for her skkills?” “ “That wouldd be very hellpful; thank yyou!” said R Raimund. K Klaus summ marized, “OK K, Raimund,, as the firstt step, I wannt you to woork with Inggrid to find the data that can help us quantify fy SR, SM, S SI, and SD.” HOW T TO INTERP PRET DATA A AND TO O TRANSFO ORM IT INT TO USABL LE INFORM MATION T Two weekss later, Klaaus, Raimunnd, Johann, and Ingridd were asssembled in the main conferennce room. R Raimund staarted, “It hass been challeenging to convert the raw w data into a usable form mat. Ingrid has spennt the last tw wo weeks diliigently combbing throughh the data, clleaning it upp, and makinng sense of the data.. I will let heer show you what she foound.” I Ingrid was excited. e Thiss was her firrst presentatiion in a real business sccenario. She was about to graduuate and hadd been seleccted for thiss competitivve internshipp position w with FarmCoo. She had worked hard on thiss assignmentt and felt thaat if she imppressed the ssenior execuutives in the room, she could lannd a career pposition withh the companny. “ “Thank you, Raimund.”” began Ingrrid. “A Supply Chain Management Farmco Study Case

As the first step to solving the problem, wee needed to identify the data to measure supplier reeliability (S SR), supplieer manageabbility (SM)), supplier importannce (SI), andd supplier diispensabilityy (SD). T higher tthe number of on-time deliveries foor a supplierr, the higherr the reliabillity of that The supplierr. Therefore,, for supplier reliability ty, I compilled the dataa on total ddeliveries annd on-time deliveriees. T assumption behind supplier maanageability is that the closer The c the geeographical pposition of a supplieer to our preemises, the eeasier it is to do businesss and manage them becaause of ease of o meeting FarmC Co The com mplexity of e evaluating s suppliers Page 4 in persoon, similar w working stanndards, low wer languagee and culturral barriers, similar govvernmental regulatioons, currencies, and timee zones, shoorter time to deliver misssing parts, leess exposuree to natural risks, leess traffic jaams and manny other sim milar reasonns. Thereforee, for suppliier manageaability, the most criitical elemennt is distancee. So I comppiled the data on geograpphical distannce. For sim mplification reasons, we calculaated the disttance based on a route-planning syystem to thee headquartters for all supplierrs and decideed to use truck as the meeans of transsport. This iss acceptable since all sup uppliers are in Europpe. M Measuring ssupplier impportance waas the most time-consum ming and coomplex taskk. The aim was to gget an idea oof how impoortant a singgle supplier is for an enttire product group. To uunderstand the impoortance of a supplier, wee have to exaactly know hhow many pproduct variaants in a prodduct group use the pparts from a given suppllier. For the loading waggon categoryy, we have 2257 variationns and 141 supplierrs. In our suppplier relatioonship manaagement sysstem, we onlly have dataa on suppliers for lead time and distance. In our matterial requirrements plannning system, we havee the data on bill of materialls for every product. Thhere is no linnk between the t two systtems. I looked at the daata on each supplier – at the levvel of parts ppurchased – in our Suppplier Relatioonship Manaagement andd Materials Requirem ment Planniing systems to identify the number of product variants forr which thatt particular supplierr supplied prooducts. S Supplier disppensability was w also diffficult. I met with the maanagers of eaach of our 15 strategic planningg groups annd requestedd they identify the timee it would take t for theem to replacce a given supplierr. The longeer it takes too switch froom a currennt supplier tto a new suupplier; the lower the w produuction. Switcching time inncludes conssiderations dispensaability of thiis supplier foor loading wagon such as finding and assessing a supplier, thee supplier obbtaining necessary certiffications, etcc. Standard parts supppliers can eeasily be repplaced, someetimes withinn 3 weeks. F For specializzed parts supppliers, the replacem ment time coould take up to one year. FarmC Co The com mplexity of e evaluating s suppliers Page 5 T followinng chart show The ws the data for five supppliers. I am rready for your questionss.” Supplieer ID 3002 3003 3006 3011 3012 Supplier Reliability (SR) Supp plier Manageeability (SM M) Total delliveries per yyear On-Time deliiveries per yeaar 1 782 28 53 423 0 11 10 36 250 Distancee from HQ Q (km m) 623 219 293 41 21 Supplier IImportance (SI) pplier Sup Dispeensability ( (SD) p variannts # product usiing parts from ma supplier 1 110 1 7 112 Time too replace a suupplier up to 3 w weeks up to 3 w weeks up to 3 w weeks >6 weekss to 6 months >6 weekss to 6 months T room w The went silent foor several seeconds. Klauus broke the silence, “Grreat work, Inngrid. You are a risiing star and will go placces. A Supply Chain Management Farmco Study Case

I am happpy we hiredd you as an inntern at Farm mCo.” J Johann and R Raimund alsso praised Inngrid. Ingridd took a deepp breath and smiled to herself. She was satisfied with heer presentatiion and was happy that tthe senior exxecutives likked her workk. J Johann had a question, “A supplier may be crittical on one measure buut not on anoother. How do we m meaningfullyy combine the data on alll four measuures to identiify critical suuppliers?” R Raimund reesponded, “IIngrid and I have alreeady started working oon the guideelines that managerrs in any prroduct groupp can use too identify critical suppliiers. We neeed some moore time to refine it.. How aboutt we meet in one week annd Ingrid annd I will pressent the guiddelines to youu.” FarmC Co The com mplexity of e evaluating s suppliers Page 6 HOW T TO USE DA ATA FOR D DECISION M MAKING E Everyone assembled in the t main connference rooom. Ingrid raan the meetinng. This tim me, she was more connfident and eeager to preseent the guideelines. I Ingrid begann, “Raimund aand I consultted with the ppurchasing m manager for lloading wagoons and the 15 strateegic product ggroup managgers. Here aree our guidelinnes: o o o o To estimate suppplier reliability (or shouldd I say, unreliiability), we ddecided to caalculate the ratio of the deliveeries not on-ttime divided to the total nnumber of deeliveries. To estimate e suppplier manageeability, we applied the ratio of the distance froom a given suppplier to the lonngest distancce from any ssupplier. To eestimate suppplier importaance, we useed the ratio of o number oof products fo for which a suppplier supplies parts dividedd by the totall number of pproducts empployed. Finally, to estim mate supplierr dispensabiility, one w way is to grooup the supppliers into diffeerent categorries and assign a score bbetween 0 and 1 based on the time needed to replaace a supplieer. After connsultation wiith purchasinng managers,, we came uup with the folloowing groupss (and scores): up to 3 weeks w (0.2), 3 to 6 weeeks (0.4), 6 w weeks to 6 montths (0.6), 6 m months to 1 yyear (0.8) andd more than 112 months (1). A After we dettermined a sccore for eachh item, we caan add up thee scores to iddentify the m most critical supplierss. I haven’t iddentified the suppliers yeet, but if you give me one week, I will get back to yyou.” J Johann was eager to unnderstand the financial iimplications,, “This is vvery interestiing and so differentt from the ussual ABC analysis based on purchasinng value thaat we traditionally use forr cash flow analysis.. I am curious how the tw wo approaches line up withh each other to rate our most m critical ssuppliers.” I Ingrid had a ready respoonse, “Raimuund and I hhad discussedd this. One w way is to coompare the number oof complaintts that are geenerated by thhe suppliers based on thee approach w we developed with those based onn the ABC annalysis. Furthhermore, we have gathereed the data onn one more pproduct groupp, ploughs, and we pplan to underrtake a similaar analysis foor both groups” K Klaus also had h an observvation, “The first supplier on your lisst has just onne delivery aand that too was late.. Do you thinnk it will affeect the rating of the suppliier? How do you plan to aaddress this iissue?” R Raimund responded, “Some more taskks for you, Inngrid!” FarmC Co The com mplexity of e evaluating s suppliers Page 7 E Everyone lauughed. Ingridd said, “Sure, I will identify the critical suppliers based b on the guidelines I presentted and baseed on the AB BC analysis. A Supply Chain Management Farmco Study Case

I will also think about how to addrress supplierrs with few deliveriees. How abouut we meet aggain in one week…” w DISCUS SSION QUE ESTIONS 1. Based B on thiss case, what are the three key challengges in using ddata for decission making?? 2. Use U traditionnal ABC analysis (using ppurchasing € value as thee benchmarkk) to identify the top 20% % s suppliers of eeach of the tw wo product ggroups. 3. Use U the guiddelines preseented by Inggrid to identiify the top 220% suppliers for each of the two p product grouups. 4. Are A the supppliers identifiied as criticall the same orr different baased on the tw wo approachhes? Which o ones are com mmon? 5. Which W approoach is better in your opinnion? Why? 6. Identify I two other measures to include for each off the four brooad measures of SR, SM, SI, and SD? F each item For m, identify hoow you will qquantify and use the data. 7. How H will youu deal with ssuppliers withh very few deeliveries, sayy less than 100 per year? FarmC Co The com mplexity of e evaluating s suppliers Page 8

Paper Title

Group X: First Name Last Name Here

Loewenberg College of Nursing, The University of Memphis

NURS 4110-501: Evidence-Based Practice Nursing

Dr. Deundra Hearne

November XX, 2021

Abstract

The purpose of this assignment is to …

Paper Title

              This is a critical appraisal of the quantitative research article. This article was published in Heart & Lung. This article was chosen because (the reasons why your group chose this article). This appraisal will focus on critiquing (focus of the critical appraisal).

Title, Authors, and Abstract

The title, “Improving quality of life and decreasing readmissions in heart failure (HF) patients in a multidisciplinary transition-to-care” identified the patient population and the key variables, quality of life and readmissions. From the title, the … (See more, p. 351)

Dr. Whitaker-Brown is a family nurse practitioner with a doctorate of nurse practice (DNP) degrees who has both clinical and research experience in the area of heart failure. Dr. Woods and Dr. Cornelius, two of the coauthors … (See more, p. 351)

The clearly written study abstract included the study problem, purpose … (See more, p. 351)

Research Problem and Purpose

From the literature discussed, the research problem could be inferred as: published studies have no examined “the feasibility and impact of a 4-week transition-to-care program on quality of life in patients with HF” (Whitaker-Brown et al., 2017, p. 80). The focus of the study was … (See more, p. 351)

Literature Review

              A minimal review of literature was presented in the introduction section of the research report. Most of the references … (See more, p. 351)

Study Framework

Whitaker-Brown and colleagues (2017) did not explicitly state the framework used for their study. … (See more, p. 351)

Variables

              Whitaker-Brown and colleagues (2018) presented demographic, independent, and dependent variables. The demographic variables of … (See more, p. 351)

Methods

Study Design

Sample and Setting

Measurement

Data Collection

Data Analyses

Results & Discussion

Interpretations of Findings

Limitations

Critique of Clinical Relevance

Nursing Implications

Future Research

Critique Summary

Authors Contribution Statement

S.L and T. L drafted the part I submissions. … All authors reviewed and agreed the final assignment.

References

White-Brown, C. D, Woods, S. J., Cornelius, J. B., Southard, E., & Gulati, S. K. (2017). Improving quality of life and decreasing readmissions in health failure patients in a multidisciplinary transition-to-care clinic. Heart & Lung, 46 (2), 79-84. https://doi.org/10.1016/j.hrtlng.2016.11.003

Main Post

Nursing Informatics is the “science and practice that integrates nursing, its information, and knowledge, with information and communication technologies to promote the health of people, families, and communities worldwide.” (IMIA,2009). This is all aimed at empowering healthcare professionals to achieve patient-centered care by collecting data and coming up with decisions that will identify the quality of care the patients need. Working as a nurse for several years, I did realize the importance of data collection, it has created a holistic view of patients, personalized treatments, advanced treatment methods, improve communication between doctors and patients, and enhance health outcomes. The Nurse Leader as Knowledge Worker Presentation.

Working at an inpatient psychiatric facility, patients to the emergency room with critical conditions especially now with Covid for further evaluation. The nurse knows that patients going to the ER don’t get to be seen by their primary healthcare doctor. Thus, while sending the patient into the ER, the nurses will be sent along with the patient’s health records which will include the patient’s ongoing treatment plan the nurse to send more detailed information regarding the patient’s current health status, ongoing. These information These health data collection includes Vital signs, Labs, faced sheets, current medication, allergy list, Polst status, and diagnostic test result. The receiving Doctor at the ER then receives the health record either by paperwork and or by electronic transmission, he uses the information to better assessed these patients to provide a better quality of care. Electronic healthcare records help to promote care coordination among healthcare workers. EHR enables clinicians treating people in a variety of settings to exchange and continuously update a patient’s clinical data and then present that information in logical clinical groupings that other clinicians can access easily (Burton et al, 2004).In this scenario, the nurse happens to send a patient to the ER in a rush and unable to print out the patient’s health care record, with the help of technology the nurses will either faxed over the patient’s health record to the receiving Dr. continuation of care.

The healthcare system continues to advance in technology in order to dignify a better quality of care for the patients. The nursing informatics shows nurses have integrated into the field of IT automatically. So they should be able to deal with it successfully to improve the quality of care outcome. In this regard, it is required to study the influence of nursing informatics on health care and make bold the appropriate information technology educational needs for nurses.

Thus a nurse leader with technological skills uses the EHR to provide quality cares to the patients, by making sure the health records are accurately gathered and easily make accessible to the other members in the care team either through fax, email, or instant messenger for continuity of care.

Slide 1 of 1

Postanesthesia Care Practice Considerations Introduction Certified registered nurse anesthetists (CRNAs) contribute to the postanesthesia care of the patient during handoff of care, postanesthesia care that may include analgesia, management of postoperative nausea and vomiting (PONV), airway management and resuscitation, discharge from the postanesthesia care unit (PACU), development of policies, and continuous quality improvement for staff education and improved processes. The CRNA role varies across practice settings and facilities in accordance with facility bylaws and policy, as well as individual competencies.1,2 The American Association of Nurse Anesthetists (AANA) provides these practice considerations to support the delivery of safe, consistent care of the patient in the postanesthesia period. These practice considerations do not apply to the recovery care of the obstetric patient who received epidural analgesia for labor and vaginal delivery. The PACU is a uniquely staffed and equipped area for monitored and protocolized care necessary for safe patient transition to the postanesthesia and/or postprocedural period. Staffing requirements and the role of the registered nurse in providing direct patient care in the PACU are set forth in the practice recommendations promulgated by the American Society of PeriAnesthesia Nurses (ASPAN) presented later in this document. Postanesthesia Care The postanesthesia period provides a monitored transition from the intraoperative or procedure period to assess and manage the patient’s hemodynamic, analgesic and general preparedness for rapid and optimal recovery.3 The PACU or separate postanesthesia recovery area, such as the surgical intensive care unit, provides resources appropriate for patients who receive sedation, regional anesthesia, or general anesthesia.4 Prior to anesthesia or during the intraoperative period, the decision to admit the patient to the PACU or intensive care area is discussed by the proceduralist and anesthesia professional. Some procedures and anesthesia techniques allow transition from the operating or procedure room to directly return to the patient room for Phase II recovery based on facility policy and criteria (discussed in more detail below). Phases of Postanesthesia Care The postanesthesia period may be separated into three levels of care: Phase I, Phase II, and Extended Care.5 Each phase of recovery may occur in one PACU or in multiple locations, which may include the patient’s room (see Table 1). In a critical care area, anesthesia and procedural transitions are integrated into the routine care and monitoring of the patient. Phase I During Phase I care, the focus is on the patient’s recovery from anesthesia and the return to baseline vital signs. Consideration is given to the procedure, anesthesia care, patient comorbidities, and the patient’s physical status to recognize, minimize and manage any issues or complications.3 Phase I includes, but is not limited to, applying PACU scoring criteria on admission and each vital signs assessment, managing respiratory and hemodynamic changes, 1 of 15 American Association of Nurse Anesthetists | 222 South Prospect Ave | Park Ridge, Illinois 60068-4001 | AANA.com Professional Practice Division l 847-655-8870 l practice@aana.com monitoring the effects of the procedure (e.g., bleeding, circulation), and providing necessary analgesia and antiemetics. While monitoring requirements are facility-specific, they are also based on the patient’s condition. ASPAN recommends assessing and documenting vital signs at least every 15 minutes during the first hour and then every 30 minutes until discharge from Phase I PACU care.5 The patient is then transitioned to Phase II, the inpatient setting, or the intensive care unit (ICU) for continued care.6 Phase II Before a patient is transitioned to Phase II care, Phase I priorities should be met (see Table 1). Post Anesthesia Care Essay.

Phase II care focuses on continued recovery and is based on facility policy and the needs of the patient.7 Phase II care most often applies to the ambulatory or same day admission. The goal of this phase is to prepare the patient to be transferred home or to an extended care facility.3 The frequency of evaluating vital signs is often facility-specific and begins on arrival and ends at discharge.5 During this phase the patient is able to ambulate, take nutrition, and receive education and instructions necessary for self-management of care at home.3 Fast Tracking Some anesthesia techniques and surgeries/procedures allow the patient to bypass Phase I care and go directly from the operating or procedure room to Phase II, a process known as “fast tracking.” Fast tracking allows the anesthesia professional and procedure team to determine that the patient has adequately recovered and has met the criteria to be transitioned to Phase II care immediately in the postanesthesia period.5 Criteria for determining whether a patient is able to be fast tracked is developed by the interdisciplinary team and documented in facility policy. Criteria for bypass of Phase I PACU may include, but are not limited to, the PACU scoring criteria, patient physical and mental status, vital signs, the type of surgery/procedure, and any complications.8 Age alone is not used as a criterion to fast track a patient.8 Adequate staffing resources on the receiving Phase II team is an important consideration in fast tracking. Communication from the procedure team to the Phase II team is essential for successful transition of care. Table 1. Role of the Anesthesia Professional in Phase I and Phase II Levels of Care4,5 Level of Possible Discharge from Phase Priorities Care Complications Considerations Phase I Stable airway with adequate ventilation and oxygenation Hemodynamic stability Manage analgesia and PONV Oral intake Discontinue or adapt IV (enhanced recovery protocol) Airway compromise Cardiovascular depression Pain Side effects: o Nausea o Vomiting Delirium Procedure- specific considerations Adequate airway and ventilatory status Cardiac and hemodynamic stability Ability to move extremities on command Fully awake Adequate oxygen saturation on room air Phase II Mobility Oral intake Adequate analgesia Education for discharge Prescriptions Pain Nausea Vomiting Adequate pain relief and comfort Hemodynamic stability Nausea addressed Takes fluids Ambulates 2 of 15 American Association of Nurse Anesthetists | 222 South Prospect Ave | Park Ridge, Illinois 60068-4001 | AANA.com Professional Practice Division l 847-655-8870 l practice@aana.com Understands discharge instructions, medications and management of any issues Safe transportation from the facility Extended Care Extended care, otherwise known as Phase III, occurs in the same physical location as care provided to Phase I and Phase II patients.5 This phase is for patients who have met criteria to leave Phase I, but are not able to go to another location (e.g., there are no available inpatient beds).6 These patients are assessed and managed as inpatients. Post Anesthesia Care Essay.

6 Anesthesia Professional Handoff to the PACU Transport to PACU or ICU Patients who are transported from the operating room to the Phase I PACU or ICU are accompanied by the anesthesia professional who is familiar with the patient’s health history, physiologic condition, and the surgery, procedure or diagnostic test performed.5 Prior to transport, the anesthesia professional and procedure team assess the patient response to anesthesia and procedure-related considerations in order to communicate complete perioperative information to the team receiving the patient. The circulating nurse, or other appropriate staff, contacts the PACU, nursing unit or ICU to confirm readiness to accept the patient. Prior to transport, the need for patient ventilation, oxygenation, monitoring, medications, and additional equipment is considered. Additionally, preparation for patient management during transport and on arrival to the recovery area is considered. Transport to the PACU and Transfer of Care During transport, the patient is continuously monitored and assessed, as appropriate.5 Oxygen and ventilatory support are provided, as indicated. On arrival to the PACU, monitoring continues or is reapplied. Standard 11 of the Standards for Nurse Anesthesia Practice states that the CRNA “evaluate[s] the patient’s status and determine[s] when it is appropriate to transfer the responsibility of care to another qualified healthcare provider.”9 The qualified healthcare provider assesses the patient’s heart rate/rhythm, systemic blood pressure, airway patency, oxygen saturation, ventilatory rate/character, temperature, level of pain, and level of consciousness and/or sedation and documents these elements of the PACU admission.7 Handoff Report After the qualified healthcare provider completes an initial patient assessment and confirms the patient is stable, the anesthesia professional and qualified healthcare provider conduct a handoff report. A handoff report is the “interprofessional transfer of critical and essential patient information, professional responsibility, and accountability from one healthcare provider to another.”10 The anesthesia professional reviews the patient’s allergies and relevant health and medication history, including medications taken or not taken that day.5 The report also includes the surgery, procedure or diagnostic test performed, antibiotic(s) administered, anesthesia and analgesia, any complications or concerns, fluids administered and volume status, and specific concerns and/or recommendations for the postanesthesia plan of care (see Table 2 for additional information).3 AANA Practice Considerations, Patient-Centered Perianesthesia Communication highlight that the handoff should be a two-way interaction, preferably face-to-face, where both healthcare providers are actively engaged in the communication.11 The environment surrounding the handoff should be free from distractions and interruptions and allow an open communication platform, including the opportunity to ask and answer questions.11 3 of 15 American Association of Nurse Anesthetists | 222 South Prospect Ave | Park Ridge, Illinois 60068-4001 | AANA.com Professional Practice Division l 847-655-8870 l practice@aana.com Studies have shown that an unstructured PACU handoff process threatens patient safety, leads to decreased satisfaction among PACU nurses, and decreases the amount of information that is transferred. Post Anesthesia Care Essay.

12 Eighty percent of serious medical errors could be due to deficient handoff communication.13,14 Known reasons for incomplete handoffs include: multitasking; lack of time, knowledge of the patient, and formal handover structure; and a chaotic environment.15 A standardized PACU handoff checklist focuses on the critical points to be addressed for a complete handoff and may decrease the duration of the verbal report.12 Omissions of critical points dramatically decrease after introduction of a standardized handoff tool.13 An interdisciplinary team develops the policy and process for handoff communication. Effective handoff mnemonics may be incorporated, including the SBAR (situation, background, assessment, recommendation), PATIENT (patient, airway, temperature, intravenous and intake/output, end-tidal carbon dioxide, narcotics, twitches) or other tool to standardize handoff communication.11,16-18 See Patient-Centered Perianesthesia Communication for additional information on handoffs. 4 of 15 American Association of Nurse Anesthetists | 222 South Prospect Ave | Park Ridge, Illinois 60068-4001 | AANA.com Professional Practice Division l 847-655-8870 l practice@aana.com Table 2. Elements to Include in the Handoff5,7,15,19,20 Patient name, age, gender / identified gender Level of consciousness / orientation Weight [for pediatric patients] Allergies / reactions Procedure(s) performed Patient Airway status Relevant patient medical and surgical/procedural history Vital signs and assessment findings Physical limitations Intraoperative course (including unanticipated intraoperative events) and considerations for management of similar issues in the PACU/ICU Positioning of patient (if other than supine) Type and difficulty of airway management Vascular access / lines / catheters Procedure Status of dressings and surgical/procedural site Fluids / losses (include drainage tubes) Crystalloid colloid / blood products Estimated blood loss Urine output Preoperative vital signs Pertinent health and medication history Health History Physical status score Preoperative cognitive function Extremity restrictions, preoperative level of activity Type of anesthesia delivered Airway management concerns Relevant lab values Vital signs and monitoring trends (CV, respiratory, neuromuscular function) Anesthesia and Medications Patient-specific procedure and hemodynamic considerations Current medications / administration / dose / timing Antiemetics Time of last and next dose of antibiotic Other intraoperative medications (steroids, antibiotics, antihypertensives, etc.) Analgesia management plan Regional anesthetic (for postoperative pain) Medications due during PACU PACU PACU orders Pain and comfort management plan 5 of 15 American Association of Nurse Anesthetists | 222 South Prospect Ave | Park Ridge, Illinois 60068-4001 | AANA.com Professional Practice Division l 847-655-8870 l practice@aana.com Patient Safety Considerations Multimodal Pain Management Due to the opioid crisis, patients and healthcare providers are increasingly interested in providing analgesia that limits or eliminates the need for opioids. Pain management techniques are evolving from the use of single-modal analgesia to engaging the patient as a member of the care team in multimodal, opioid-sparing analgesia through enhanced recovery pathways. Post Anesthesia Care Essay.

21 This approach supports a more rapid recovery by engaging patients in early drinking, eating, and mobilizing after the procedure.3 Patients are encouraged to resume their normal diet and activities of daily living on the day of surgery.21 Additional information regarding patient engagement in the perioperative analgesia plan of care can be found in the AANA Enhanced Recovery after Surgery – Considerations for Pathway Development and Implementation. Postoperative Nausea and Vomiting Although PONV affects 20 to 30 percent of all patients, the incidence of PONV in high-risk patients is as high as 70 to 80 percent.3 The Apfel Score is one tool to assess PONV risk factors.21 The four risk factors of the Apfel Score are female gender, history of motion sickness or PONV, nonsmoker, and postoperative opioid administration.3 The following strategies may be considered to reduce the risk of PONV:21 Regional anesthesia Propofol induction and maintenance of anesthesia Avoiding the use of nitrous oxide Minimizing opioid administration Adequate hydration Like pain management, PONV management is optimized when several receptors are treated.4 Pharmacologic management is based on the patient’s PONV risk and the procedure. Prophylactic approaches are especially effective for high-risk patients.3 For adults at moderate risk, it is recommended that one to two prophylaxis interventions are used.22 Example classes include, but are not limited to, 5-hydroxytryptamine and neurokinin-1 receptor antagonists, butyrophenones, antihistamines, corticosteroids, and anticholinergics.22 If unable to treat PONV prophylactically, therapeutic medications may include the scopalomine patch and/or ondansetron.4 Obstructive Sleep Apnea Evidence suggests that at least 25 million patients experience some form of obstructive sleep apnea (OSA).23 Moreover, about 12 to 18 million patients are undiagnosed, which can be problematic for both the patient and the healthcare professionals caring for them.3 Incorporating the standardized screening tools, such as the Berlin Questionnaire (BQ) and STOP-Bang (snoring, tired, observed, pressure, body mass index, age, neck size, gender) clinical scale, can identify risk of OSA preoperatively.5 The STOP-Bang clinical scale is an easy-to-use and validated tool to identify undiagnosed patients who may be at risk of moderate to severe OSA.5 Patients with a known diagnosis of OSA are 24 percent more likely to experience postoperative complications, including significant periods of apnea.24,25 There may also be difficulty with ventilation, laryngoscopy and intubation.24,25 The presence of other coexisting conditions can increase the risk of respiratory complications.26 Patients who use a continuous positive airway 6 of 15 American Association of Nurse Anesthetists | 222 South Prospect Ave | Park Ridge, Illinois 60068-4001 | AANA.com Professional Practice Division l 847-655-8870 l practice@aana.com pressure (CPAP) device at home should bring the device to the facility and continue to use it postoperatively.27 OSA patients that use their CPAP postoperatively are less likely to encounter postoperative complications.25,27-29 Patients Who Receive IV Opioids in the PACU Attentive monitoring of patients who receive IV opioids in the PACU includes respiratory status, sedation levels, and assessments of pain.30 The U.S. Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (CoPs) Survey Protocol, Regulations and Interpretive Guidelines for Hospitals, Section 482.23(c)(4) Interpretive Guidelines, requires that hospitals have policies and procedures in place for postoperative patients receiving high-alert medications, such as IV opioids. Post Anesthesia Care Essay.

30 These policies and procedures must address “the process for patient risk assessment, including who conducts the assessments, and, based on results of the assessment, monitoring frequency and duration, what is to be monitored, and monitoring methods.”30 Monitoring for over-sedation and respiratory depression related to IV opioids must be included. Consult the CMS Interpretive Guidelines for additional information.30 End -Tidal CO2 Monitoring Multiple risk factors for respiratory compromise secondary to postoperative opioid-induced respiratory depression (OIRD) have been identified, including extremes of age, obesity, obstructive sleep apnea, neurologic disease, and cardiovascular disease, among others.31-33 Postoperative pulmonary complications may also occur unrelated to opioid administration. Many organizations recommend continuous electronic monitoring of oxygenation and ventilation for early identification of respiratory depression.31,34 Postoperative pulmonary complications may also occur unrelated to opioid administration.33,35 Postoperative capnography should be considered for continuous monitoring of end-tidal CO2 and earlier detection of catastrophic respiratory events.31,34 Postoperative Delirium Postoperative delirium is an adverse event that can occur in the postoperative period. Patients over the age of 65 are more likely to experience postoperative delirium, with general surgery incidences ranging from five to 15 percent.3,36 This rate increases to as high as 62 percent after operative hip fractures.3,36 Causes include, but are not limited to, withdrawal psychosis, toxic psychosis, circulatory and respiratory origin, and functional psychosis.3 Delirium is associated with poor outcomes (e.g., functional decline, persistent cognitive decline, increased risk of dementia, risk of post-discharge institutionalization, and death), increased length of stay, and increased healthcare costs. Timely diagnosis is crucial to prevent patients from developing severe long-lasting complications.37 If preexisting cognitive impairment exists, the risk for postoperative delirium rises with anesthesia and surgery.37,38 Preexisting cognitive impairment is not always obvious, therefore a preoperative screening for at-risk patients may minimize the impact of postoperative delirium, whether the diagnosis is suspected on clinical grounds (e.g., in the agitated patient) or not (as is common in hypoactive delirium).38 If delirium is detected in the PACU, pharmacologic treatments for delirium include typical and atypical antipsychotics. The first-generation antipsychotics haloperidol and chlorpromazine, as well as the second-generation antipsychotics olanzapine and risperidone, all appear to be equally effective treatments for established delirium.37 7 of 15 American Association of Nurse Anesthetists | 222 South Prospect Ave | Park Ridge, Illinois 60068-4001 | AANA.com Professional Practice Division l 847-655-8870 l practice@aana.com Residual Neuromuscular Blockade Residual neuromuscular blockade, defined as a train-of-four (TOF) ratio 40 percent, 20 to 40 percent, or with 20 percent of preoperative vital signs Surgical bleeding – severe, moderate, minimal Post Anesthesia Care Essay.

Activity and mental status – patient orientation and gait Intake and Output – assessment of fluids and voiding Pain/Nausea/Vomiting – severe, moderate, minimal CMS Regulations Hospitals CMS CoPs Survey Protocol, Regulations and Interpretive Guidelines for Hospitals, Section 482.52(b)(3), requires “[a] postanesthesia evaluation completed and documented by an individual qualified to administer anesthesia no later than 48 hours after surgery or a procedure requiring anesthesia services.”30 The postanesthesia evaluation for anesthesia recovery must be completed in accordance with state law and hospital policies and procedures that reflect current standards of anesthesia care. The CMS Interpretive Guidelines state that the 48-hour time frame begins once the patient has been transferred to the PACU or other recovery location and has “sufficiently recovered from the acute administration of the anesthesia.”30 CMS does not require a postanesthesia evaluation for patients receiving moderate sedation.30 9 of 15 American Association of Nurse Anesthetists | 222 South Prospect Ave | Park Ridge, Illinois 60068-4001 | AANA.com Professional Practice Division l 847-655-8870 l practice@aana.com The CMS Interpretive Guidelines require that elements of the postanesthesia evaluation, which must be documented in the healthcare record and “conform to current standards of anesthesia care,” include: Respiratory function, including respiratory rate, airway patency, and oxygen saturation; Cardiovascular function, including pulse rate and blood pressure; Mental status; Temperature; Pain; Nausea and vomiting; and Postoperative hydration.”30 Please consult applicable accreditation standards in addition to state law for relevant postanesthesia care requirements. Ambulatory Surgery Centers The CMS Conditions for Coverage (CfC) Guidance for Surveyors: Ambulatory Surgical Centers (ASC), Section 416.42(a), requires an evaluation of proper anesthesia recovery before the patient is discharged from the ASC.53 This evaluation must be completed and documented by a physician or an anesthesia professional and must be in accordance with applicable state law, standards of practice, and ASC policy. CMS does not require a postanesthesia evaluation for patients receiving moderate sedation.53 Unlike the Hospital Interpretive Guidelines, the ASC Interpretive Guidelines do not dictate elements of the postanesthesia evaluation, but state that ASCs would be well advised in developing their policies and procedures for postanesthesia care to consult recognized guidelines.53 Please consult applicable accreditation standards in addition to state law for relevant postanesthesia care requirements. Post-Facility Transportation Sedation and anesthesia have been shown to impair decision-making and ability to operate equipment for a period of time. Patients should have a responsible adult who is able to safely transport the patient home, or a facility needs to establish policies and procedures if an exception is made.5,52 Age is one factor that determines a responsible adult; however, any individual who can provide post-procedure care at home and report any post-procedure or postanesthesia complications may be considered for inclusion in a facility’s discharge policies and procedures. Post Anesthesia Care Essay.

52,54 For the patient who does not have transportation home, it must be determined before the surgery/procedure whether:5,52 Medical transportation can be arranged The patient will be admitted for observation, or The case will be cancelled and rescheduled. For a pediatric patient, if a car seat is required preadmission, ASPAN recommends that two adults travel home with the patient with one driving and one sitting with the child.5 For more information, review the AANA Position Statement and Policy Considerations, Discharge After Sedation or Anesthesia on the Day of the Procedure. 10 of 15 American Association of Nurse Anesthetists | 222 South Prospect Ave | Park Ridge, Illinois 60068-4001 | AANA.com Professional Practice Division l 847-655-8870 l practice@aana.com Patient/Family Education When the patient and family/caregiver contribute to the development of the care plan, the patient has an improved ability for self-care and prevention of post-procedure complications.55 The care team provides preoperative education and discharge education and instructions that are reviewed for understanding prior to discharge.52 Language, cultural and religious beliefs, and health literacy may also impact a patient’s understanding of the discharge process and instructions.56 Review the AANA Policy and Practice Considerations, Informed Consent for Anesthesia Care, for information and strategies to address communication, health literacy, and cultural competency. Review Discharge After Sedation or Anesthesia on the Day of the Procedure for more information on patient and family/caregiver discharge instructions. PACU Staffing The following recommendations for staffing of Phase I and II PACUs and Extended Care are provided from the ASPAN Perianesthesia Nursing Standards, Practice Recommendations and Interpretive Statements, which are consistent with the Association of periOperative Registered Nurses (AORN) Position Statement on Perioperative Safe Staffing and On-Call Practices. Please contact these organizations or the AANA to confirm that the listed recommendations are current. Phase I PACU: “Two registered nurses, one of whom is an RN [Registered Nurse] competent in Phase I postanesthesia nursing, are in the same room/unit where the patient is receiving Phase I level of care.”5,57 Phase II PACU: “Two competent personnel, one of whom is an RN competent in Phase II post anesthesia nursing in the same room/unit where the patient is receiving Phase II level of care. An RN must be in the Phase II PACU at all times while a patient is present.”5,57 Extended Care: “Two competent personnel, one of whom is an RN possessing competence appropriate to the patient population, are in the same room/unit where the patient is receiving extended level of care.”5 References for Policy Development Facilities engage an interdisciplinary team to develop policies and procedures related to care provided in the PACU setting. During policy and procedure development, consult applicable federal, state and local law and accreditation standards for inclusion. Post Anesthesia Care Essay.

These sources may include, but are not limited to: CMS Conditions of Participation (CoP) Regulations and Interpretive Guidelines for Hospitals CMS Conditions for Coverage (CfC) Guidance for Surveyors: Ambulatory Surgical Centers (ASC) State and local laws, regulations and regulatory bodies (e.g., the Department of Health) Facility Accreditors (e.g., The Joint Commission, DNV GL Healthcare, Healthcare Facilities Accreditation Program, Accreditation Association for Ambulatory Health Care, American Association for Accreditation of Ambulatory Surgery Facilities) 11 of 15 American Association of Nurse Anesthetists | 222 South Prospect Ave | Park Ridge, Illinois 60068-4001 | AANA.com Professional Practice Division l 847-655-8870 l practice@aana.com Conclusion The transition from anesthesia care to safe recovery begins with delivery of anesthesia care that limits postoperative side effects and complications. Clear and complete hand-off communication supports the PACU team in continuing the care and achieving the outcomes sought by the patient and family/caregiver. The CRNA has the opportunity to contribute to perioperative policy development and continuous quality improvement activities to improve processes and patient outcomes. References 1. Scope of nurse anesthesia practice. Park Ridge, IL: American Association of Nurse Anesthetists; 2016. 2. Clinical privileges and other responsibilities of certified registered nurse anesthetists. Park Ridge, IL: American Association of Nurse Anesthetists; 2019. 3. Odom-Forren J, Brady JM. Postanesthesia recovery. Nagelhout JJ, Sass, E, ed. Nurse Anesthesia. 6 ed. St. Louis, MO: Elsevier; 2018:1147-1166. 4. Nicholau D. The postanesthesia care unit. Miller RD, Eriksson LR, Fleisher LA, WeinerKronish JP, Young WL, eds. Miller’s Anesthesia. 7 ed. Philadelphia, PA: Churchill Livingstone; 2010:2707-2728. 5. Perianesthesia Nursing Standards Pratice Recommendations and Interpretive Statements. Cherry Hill, NJ: American Society of PeriAnesthesia Nurses; 2017. 6. American Society of PeriAnesthesia Nurses (ASPAN). Frequently asked questions. What are the differences between Phase I, Phase II, and Extended Care (Extended Observation/Phase III)? Web site. http://www.aspan.org/Clinical-Practice/FAQs#11. Published 2017. Accessed July 19, 2019. 7. Fowler MA, Spiess BD. Postanesthesia recovery. Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega RA, eds. Clinical Anesthesia. 7 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:1556-1579. 8. Waseem Z, Lindner J, Sgouropoulou S, et al. Independent risk factors for fast-track failure using a predefined fast-track protocol in preselected cardiac surgery patients. J Cardiothorac Vasc Anesth. 2015;29(6):1461-1465. 9. Standards for Nurse Anesthesia Practice. Park Ridge, IL: American Association of Nurse Anesthetists; 2019. 10. Rose MW, Newman S, Brown C. Postoperative information transfers: An integrative review. J Perianesth Nurs. 2019;34(2):403-424 e403. 11. Patient-Centered Perianesthesia Communication. Park Ridge, IL: American Association of Nurse Anesthetists; 2014. 12. Halladay ML, Thompson JA, Vacchiano CA. Enhancing the quality of the anesthesia to postanesthesia care unit patient transfer through use of an electronic medical recordbased handoff tool. J Perianesth Nurs. 2018. 13. Halterman RS, Gaber M, Janjua MST, Hogan GT, Cartwright SMI. Post Anesthesia Care Essay.

Use of a checklist for the postanesthesia care unit patient handoff. J Perianesth Nurs. 2019. 14. Milby A, Bohmer A, Gerbershagen MU, Joppich R, Wappler F. Quality of post-operative patient handover in the post-anaesthesia care unit: a prospective analysis. Acta Anaesthesiol Scand. 2014;58(2):192-197. 15. Piekarski F, Kaufmann J, Laschat M, Bohmer A, Engelhardt T, Wappler F. Quality of handover in a pediatric postanesthesia care unit. Paediatr Anaesth. 2015;25(7):746-752. 16. Riesenberg LA, Leitzsch J, Little BW. Systematic review of handoff mnemonics literature. Am J Med Qual. 2009;24(3):196-204. 12 of 15 American Association of Nurse Anesthetists | 222 South Prospect Ave | Park Ridge, Illinois 60068-4001 | AANA.com Professional Practice Division l 847-655-8870 l practice@aana.com 17. Randmaa M, Martensson G, Leo Swenne C, Engstrom M. SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: A prospective intervention study. BMJ Open. 2014;4(1):e004268. 18. Wright SM. Examining transfer of care processes in nurse anesthesia practice: introducing the PATIENT protocol. AANA J. 2013;81(3):225-232. 19. Potestio C, Mottla J, Kelley E, DeGroot, K. Improving post anesthesia care unit (PACU) handoff by implementing a succinct checklist. Anesth Patient Safety Found. 2015;30(1). 20. Documenting anesthesia care. Park Ridge, IL: American Association of Nurse Anesthetists; 2016. 21. Enhanced recovery after surgery. Park Ridge, IL: American Association of Nurse Anesthetists; 2017. 22. Piljac J. Consensus guidelines for the prevention of postoperative nausea and vomiting. https://www.empr.com/home/features/consensus-guidelines-for-the-prevention-ofpostoperative-nausea-and-vomiting/2/. Published 2018. Accessed July 19, 2019. 23. American Academy of Sleep Medicine. Rising prevalence of sleep apnea in U.S. threatens public safety. https://aasm.org/rising-prevalence-of-sleep-apnea-in-u-sthreatens-public-health/. Published 2014. Accessed July 19, 2019. 24. Brousseau CA, Dobson GR, Milne AD. A retrospective analysis of airway management in patients with obstructive sleep apnea and its effects on postanesthesia care unit length of stay. Can J Respir Ther. 2014;50(1):23-26. 25. Diffee PD, Beach MM, Cuellar NG. Caring for the patient with obstructive sleep apnea: implications for health care providers in postanesthesia care. J Perianesth Nurs. 2012;27(5):329-340. 26. Setaro J, Reinsel R, Brun D. Preoperative screening for obstructive sleep apnea and outcomes in PACU. J Perianesth Nurs. 2019;34(1):66-73. 27. Chung F, Nagappa M, Singh M, Mokhlesi B. CPAP in the perioperative setting. CHEST. 2016;149(2):586-597. 28. Moos DD, Prasch M, Cantral DE, Huls B, Cuddeford JD. Are patients with obstructive sleep apnea syndrome appropriate candidates for the ambulatory surgical center? AANA J. 2005;73(3):197-205. 29. Borg L, Walters TL, Siegel LC, Dazols J, Mariano ER. Use of a home positive airway pressure device during intraoperative monitored anesthesia care for outpatient surgery. J Anesth. 2016;30(4):707-710. 30. U.S. Centers for Medicare & Medicaid Services. State Operations Manual: Appendix A Survey Protocol, Regulations and Interpretive Guidelines for Hospitals. Baltimore, MD: U.S. Centers for Medicare & Medicaid Services; 2011:486-488. 31. Geralemou S, Probst S, Gan TJ. The role of capnography to prevent postoperative respiratory adverse events. Post Anesthesia Care Essay.

Anesth Patient Safety Found. 2016;31(2):42-43. 32. Arozullah AM, Daley J, Henderson WG, Khuri SF. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. Annals of Surgery. 2000;232(2):242-253. 33. Weingarten TN, Herasevich V, McGlinch MC, et al. Predictors of delayed postoperative respiratory depression assessed from naloxone administration. Anesth Analg. 2015;121(2):422-429. 34. Spratt GK. Assessing patient risk of opioid-induced respiratory compromise. RT. 2019(March-April):22-25. 35. Dahan A, Aarts L, Smith TW. Incidence, reversal, and prevention of opioid-induced respiratory depression. Anesthesiology. 2010;112(1):226-238. 13 of 15 American Association of Nurse Anesthetists | 222 South Prospect Ave | Park Ridge, Illinois 60068-4001 | AANA.com Professional Practice Division l 847-655-8870 l practice@aana.com 36. American Society of Anesthesiologists. What is the perioperative brain health initiative? https://www.asahq.org/brainhealthinitiative/about. Published 2019. Accessed July 19, 2019. 37. Whitlock EL, Vannucci A, Avidan MS. Postoperative delirium. Minerva Anestesiol. 2011;77(4):448-456. 38. The American Society of Anesthesiologists. The American Society of Anesthesiologists (ASA)/American Association of Retired Persons (AARP) perioperative brain health initiative summit: Innovations to promote brain health before, during and after surgery – attendee summary. https://www.asahq.org/brainhealthinitiative/news/summit. Accessed July 22, 2019. 39. Murphy GS, Szokol JW, Avram MJ, et al. Postoperative residual neuromuscular blockade is associated with impaired clinical recovery. Anesth Analg. 2013;117(1):133141. 40. Brull SJ, Kopman AF. Current status of neuromuscular reversal and monitoring: Challenges and opportunities. Anesthesiology. 2017;126(1):173-190. 41. Gätke MR, Viby-Mogensen J, Rosenstock CV, Jensen FS, Skovgaard LT. Postoperative muscle paralysis after rocuronium: less residual block when acceleromyography is used. Acta Anaesthesiol Scand. 2002;46(2):207-213. 42. Cammu G, De Witte J, De Veylder J, et al. Postoperative residual paralysis in outpatients versus inpatients. Anesth Analg. 2006;102(2):426-429. 43. Kim KS, Cheong MA, Lee HJ, Lee JM. Tactile assessment for the reversibility of rocuronium-induced neuromuscular blockade during propofol or sevoflurane anesthesia. Anesth Analg. 2004;99(4):1080-1085. 44. Fortier L, McKeen D, Turner K, et al. The RECITE study: A Canadian prospective, multicenter study of the incidence and severity of residual neuromuscular blockade. Anesth Analg. 2015;121(2):366-372. 45. Aytac I, Postaci A, Aytac B, et al. Survey of postoperative residual curarization, acute respiratory events and approach of anesthesiologists. Braz J Anesthesiol. 2016;66(1):55-62. 46. Strauss PZ, Lewis MM. Identifying and treating postanesthesia emergencies. OR Nurse. 2015;9(6):24-30. 47. Murphy G. Presentation of the APSF collaborative panel on neuromuscular blockade and patient safety at the 2017 ASA annual meeting. Post Anesthesia Care Essay.

Anesth Patient Safety Found. 2018;32(3):68-69. 48. Malignant Hyperthermia Crisis Preparedness and Treatment. Park Ridge, IL: American Association of Nurse Anesthetists; 2018. 49. Petty WC. Closing the hand hygiene gap in the postanesthesia care unit: a body-worn alcohol-based dispenser. J Perianesth Nurs. 2013;28(2):87-93; quiz 94-87. 50. Carter AJ, Deselms J, Ruyle S, et al. Postanesthesia care unit visitation decreases family member anxiety. J Perianesth Nurs. 2012;27(1):3-9. 51. Fumagalli S, Boncinelli L, Lo Nostro A, et al. Reduced cardiocirculatory complications with unrestrictive visting policy in an intensive care unit – results from a pilot, randomized trial. Circulation. 2006;113(7):946-952. 52. Discharge after sedation or anesthesia on the day of the procedure: Patient transportation with or without a responsible adult. Park Ridge, IL: American Association of Nurse Anesthetists; 2018. 53. U.S. Centers for Medicare & Medicaid Services. State Operatons Manual: Appendix L Guidance for Surveyors: Ambulatory Surgical Centers. Baltimore, MD: U.S. Centers for Medicare & Medicaid Services; 2009:51-52. 14 of 15 American Association of Nurse Anesthetists | 222 South Prospect Ave | Park Ridge, Illinois 60068-4001 | AANA.com Professional Practice Division l 847-655-8870 l practice@aana.com 54. American Society of PeriAnesthesia Nurses (ASPAN). Frequently asked questions. What is the definition of “responsible adult?” Web site. http://www.aspan.org/ClinicalPractice/FAQs#8. Published 2017. Accessed July 22, 2019. 55. Marley RA, Sheets SA. Preoperative evaluation and preparation of the patient. Nagelhout JJ, Sass, E, ed. Nurse Anesthesia. 6 ed. St. Louis, MO: Elsevier; 2018:311345. 56. Informed consent for anesthesia care. Park Ridge, IL: American Association of Nurse Anesthetists; 2016. 57. AORN Position Statement on Perioperative Safe Staffing and On-Call Practices. Denver, CO: Association of periOperative Registered Nurses; 2014. ____________________________________________________________________________ Adopted by AANA Board of Directors August 2019 © Copyright 2019 15 of 15 American Association of Nurse Anesthetists | 222 South Prospect Ave | Park Ridge, Illinois 60068-4001 | AANA.com Professional Practice Division l 847-655-8870 l practice@aana.com

FPX 6218 Assessing Jordan Community Health Care Needs Paper

FPX 6218 Assessing Jordan Community Health Care Needs Paper

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Assessment 2 Instructions: Assessing Community Health Care Needs

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• PRINT
• Assess the health care needs of a selected community by completing an environmental analysis and a virtual windshield survey. Summarize the results of your assessment in a 2-3 page executive summary.

Introduction

Health care must be evidence-based, effective, efficient, and affordable; it must provide resources that meet the needs of the community. Nurse leaders must understand and thoroughly evaluate the environment to enable the efficient and equitable allocation of resources. A useful tool for this type of assessment is commonly called a windshield survey. Windshield surveys are what you might expect from the name. They are a way of gathering information about specific aspects of a community while driving around, such as the condition of roads, buildings, and housing.

This assessment provides an opportunity to examine the prevailing health conditions and social determinants of health in a community by completing an environmental analysis and a virtual windshield survey based on communities within the Vila Health system. Although Vila Health is a virtual lab, the communities represented in this simulation are real, enabling you to conduct an actual community health assessment. FPX 6218 Assessing Jordan Community Health Care Needs Paper

Preparation

Executive leaders at Vila Health have asked you to provide them with your assessment of the health conditions in one of the communities served by the Vila Health system. Knowing that a windshield survey is needed to validate any underlying assumptions about the needs of the community and inform evidence-based decision making and strategic planning, you have decided to conduct a first-hand exploration of the community, followed up by an environmental analysis. An environmental analysis examines the factors that can influence the performance of a health care organization, which is important in a rapidly changing health care environment.

To prepare for the assessment, you are encouraged to begin thinking about how an environmental analysis and windshield survey contribute to assessing community health care needs. In addition, you may wish to:

Note: Remember that you can submit all or a portion of your draft assessment to Smarthinking Tutoring for feedback before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.

The following resource is required to complete the assessment.

Vila Health is a virtual environment that simulates a real-world health care system. In the various Vila Health scenarios, you will apply professional strategies, practice skills, and build competencies that you can apply to your coursework and in your career. The information you gather in this scenario will help you to complete the assessment.

TEMPLATES

Use this template for your community health assessment.

Requirements

Complete this assessment in two steps:

5. If you have not already done so, complete the Vila Health: Environmental Analysis and Windshield Survey simulation.
6. Write an executive summary of your community health assessment, based on your windshield survey and environmental analysis.

The community health assessment requirements outlined below, correspond to the grading criteria in the scoring guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed. The Guiding Questions: Assessing Community Health Care Needs document provides additional considerations that may be helpful in completing your assessment. In addition, be sure to note the requirements below for document format and length and for citing supporting evidence.

• • Assess, via a windshield survey, the general condition and needs of a community from a public health perspective.
  • Analyze the environmental factors affecting population health in a community.
  • Identify the social determinants of health in a community.
  • Summarize windshield survey and environmental analysis findings for executive leaders.
  • Write clearly and concisely in a logically coherent and appropriate form and style.
  • Support findings and conclusions with relevant and credible evidence.

Document Format and Length

• • Use the Community Health Assessment Template. This APA Style Paper Tutorial [DOCX] can help you in writing and formatting your assessment. If you would like to use a different worksheet for your community health assessment, obtain prior approval from faculty.
  • The executive summary portion of your survey and analysis should be 2–3 pages in length.
  • Be sure to apply correct APA formatting to all source citations and references.

Supporting Evidence

Cite 3–5 credible sources from peer-reviewed journals or professional industry publications to support your executive summary.

Additional Requirements

Proofread your executive summary before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your assessment.

Portfolio Prompt: You may choose to save your community health assessment to your ePortfolio.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• • Competency 1: Identify the challenges and opportunities facing health care.

• • • Assess, via a windshield survey, the general condition and needs of a community from a public health perspective.
    • Analyze the environmental factors affecting population health in a community.
    • Identify the social determinants of health in a community.
  • Competency 4: Develop proactive strategies to change the culture of the organization by incorporating evidence-based practices.

• • • Summarize windshield survey and environmental analysis findings for executive leaders.
  • Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style consistent with applicable organizational, professional, and scholarly standards.

• • • Write clearly and concisely in a logically coherent and appropriate form and style.
    • Support assertions, arguments, propositions, and conclusions with relevant and credible evidence.

Use the scoring guide to understand how your assessment will be evaluated.

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